Abstract [en]

GOALS OF WORK: The purpose of this study was to better understand various variables related to food intake and eating problems in children with cancer during their chemotherapy. PATIENTS AND METHODS: Twenty-two consecutively admitted children, diagnosed with cancer and undergoing chemotherapy, participated in this study. Twenty-one of them, their parents and attending nurses participated in semi-structured interviews. Ten of the children underwent a taste acuity test, and recognition thresholds for the four basic tastes were determined. MAIN RESULTS: The shared view of both children and parents was that altered taste was the predominant cause of the eating problems. In contrast, the nurses perceived that nausea was the most important cause of the children's eating problems. In addition, psychological aspects such as learned food aversions and negative attitudes towards hospital food were regarded as important by children, parents and nurses. The taste test showed that the patients had higher thresholds for bitter taste and made more taste recognition errors compared to controls. CONCLUSIONS: Changes seem to exist both in the primary gustatory sense as well as in food perception in paediatric cancer patients undergoing chemotherapy. Single solutions, such as efforts to serve "tasty food", do not suffice alone. A more effective solution may be to combine different strategies and combinations of oral, enteral and parenteral nutrition should be considered to prevent malnutrition.

Skolin, Inger

Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.

2005 (English)Doctoral thesis, comprehensive summary (Other academic)

Abstract [en]

Background: Chemotherapy has side effects that may interfere with food intake. Children suffering from a malignant disease are subjected to treatment with chemotherapy. They may therefore become at risk of undernutrition during the period of treatment. This in turn may increase the risk of infections, delayed therapy and influence the outcome of treatment. Few studies have investigated how children undergoing chemotherapy for cancer perceive food and eating. Attempts to improve food intake and the nutritional status require an understand-ing of how eating patterns are altered during chemotherapy in children.

Study design: Dietary information and anthropometric data were collected after the initiation of chemotherapy in 14 children, consecutively admitted to the Paediatric Haematology and Oncology Unit at Umeå University Hospital. This initial study resulted in the establishment of more flexible mealtime routines on the ward. A follow-up study was conducted with another group of 11 children. Interviews were performed with a third group of 21 consecutively ad-mitted children, their parents and attending nurses. The focus was on the children’s own per-ception of and their parents’ and nurses’ attitudes to their food intake during hospitalisation. Recognition thresholds for the basic tastes were determined with 10 of the oldest of these children and 10 healthy controls.

Results: Before introduction of new mealtime routines, the average daily oral energy intake during hospitalisation was 58% of the Swedish Nutrition Recommendations, SNR. The chil-dren had a significant weight loss up to three months after onset of chemotherapy. After the introduction of new mealtime routines, the average daily oral intake on hospital days was 61% of SNR and thus still lower than recommended despite efforts to serve palatable food on the ward. When enteral and parenteral nutrition was included, the energy intake came close to that recommended for healthy children, 91% of SNR. Both children and parents perceived that altered taste was an important cause of the children’s eating problems. The children also viewed food aversions, nausea and vomiting and pain as important causes, while the parents perceived nausea, food aversions and altered smell as significant factors. The nurses on the other hand, viewed nausea, the ward environment, and food rejection as a way of gaining some influence over the situation as important factors. The patients had significantly higher thresholds for bitter taste and significantly more patients made mistakes in taste recognition compared with controls.

Conclusion and clinical implication: There seem to be changes both in the sense of taste as well as in the perception of food in children undergoing chemotherapy for malignant disease. Thus, single solutions such as providing a variety of “tasty food” in the hospital setting in order to improve food intake does not suffice for many paediatric cancer patients. The indi-vidual’s food preferences and aversions should be considered and combinations of oral, en-teral and parenteral nutrition support should be provided.